Provider First Line Business Practice Location Address:
2187 POYNTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-670-4348
Provider Business Practice Location Address Fax Number:
270-710-1408
Provider Enumeration Date:
10/25/2006